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American Heart Association Issues E-Cigarette Recommendations

Statement reinforces need for tough restrictions on sales and marketing to youth

The American Heart Association (AHA) has issued new policy recommendations on the use of e-cigarettes and their impact on tobacco-control efforts. The guidance was published in the association’s journal, Circulation.

Based on the current evidence, the AHA’s position is that e-cigarettes that contain nicotine are tobacco products and should be subject to all laws that apply to these products. The group also calls for strong new regulations to prevent access, sales and marketing of e-cigarettes to youth, and for more research into the product’s health effects.

“Over the last 50 years, 20 million Americans died because of tobacco. We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers,” said the AHA’s CEO, Nancy Brown. “Recent studies raise concerns that e-cigarettes may be a gateway to traditional tobacco products for the nation’s youth, and could renormalize smoking in our society. These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched, and closely monitored.”

“E-cigarettes have caused a major shift in the tobacco-control landscape,” said lead author Aruni Bhatnagar, PhD, FAHA. “It’s critical that we rigorously examine the long-term impact of this new technology on public health, cardiovascular disease, and stroke, and pay careful attention to the effect of e-cigarettes on adolescents.”

The policy statement recommends a federal ban on e-cigarettes for minors and details concerns that these products may be another entry point for nicotine addiction among young people. The authors cite a JAMA Pediatrics study of 40,000 middle and high school students, which indicated that adolescents consider e-cigarettes as high-tech, accessible, and convenient, especially in places where smoking cigarettes is not allowed.

The association recommends strict laws that curb the intense marketing and advertising of e-cigarettes, and that ban flavorings in these products.

In addition to federal oversight of e-cigarettes, the AHA guidance also examines state smoke-free laws in relation to these products. While the levels of toxic substances in e-cigarettes are lower than those in cigarette smoke, non-smokers could be involuntarily exposed to nicotine in any confined space where e-cigarettes are used. Given these concerns, the association supports including e-cigarettes in state laws, if the change can be made without weakening existing laws.

Another key recommendation examines e-cigarettes in tobacco-cessation counseling. The statement points to the lack of evidence establishing e-cigarettes as a primary smoking-cessation aid. Some studies suggest that the use of e-cigarettes to help smokers quit may be equal to or slightly better than nicotine patches. The AHA will continue to encourage clinicians to use proven smoking-cessation strategies as the first-line of treatment for any patient. But the association reiterates in its statement that when repeated efforts with conventional treatment fail, are not tolerated, or are rejected by a patient who wants to use e-cigarettes to help them quit, clinicians should not discourage their use by the patient.

However, the statement stresses that clinicians should be educated so that they can inform patients that e-cigarettes are unregulated, may contain low levels of toxic chemicals, and have not been FDA-approved as cessation devices. The association also proposes that, given the lack of long-term research studies on e-cigarette safety, it is appropriate for a health care professional to suggest that a patient set a quit date for their e-cigarette use.

Finally, in the new statement, the AHA calls for comprehensive and continuous research on the use of e-cigarettes, their characteristics, their marketing, and their long-term health effects on individual users, the environment, and public health.

Source: AHA; August 25, 2014.

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